Femoral Nerve Palsy Secondary to Iliopsoas Spontaneous Haematoma in a Patient Under Warfarin Treatment

Abstract

Femoral nerve palsy secondary to iliopsoas non-traumatic haematoma is a scarce complication with a treatment approach that remains controversial between conservative and surgical intervention. We present a case of a 64-year-old male patient under warfarin medication, who developed severe left hip and anterior thigh pain and femoral nerve palsy with no history of trauma. Laboratory studies revealed a prolonged international normalized ratio level of 4.5, and imaging studies revealed a large haematoma surrounding the left iliopsoas muscle (35 cm x 9 cm x 6 cm). The patient was treated conservatively with discontinuation of his anticoagulation remedy and vitamin K administration and recovered almost fully after eight months, following a rehabilitation programme. Patients who are on anticoagulants should raise a high index of suspicion. Conservative management can provide a good outcome; it requires, however, a long period of rehabilitation.

Iliopsoas hematoma in patients with COVID-19 on low-molecular-weight heparin treatment

“…In the second report, Mazzitelli et al 16 described two cases: a 74-year-old man treated with LMWH at a dosage of 4000 IU twice a day for atrial fibrillation (AF) who died of severe anemia resulting from IPH, with a worsening prolongation of PT and PTT during hospitalization, and a 56-year-old man with stroke and renal failure also treated with LMWH 4000 twice a day for AF, with a normal coagulation pattern at the time of admission, and onset of IPH after 27 days: at the time of the diagnosis of hemorrhage, only PT was moderately increased and an unspecified thrombocytopenia was noted. There are also other reports in the literature concerning idiopathic IPH in anticoagulated patients even if not affected by COVID-19: Apostolopoulos et al 17 described a man treated with warfarin who developed extensive IPH with femoral nerve palsy. A similar case is reported by Watanabe et al 18 where a patient, also on warfarin treatment, developed a rhabdomyolysis caused by bilateral IPH.…”

Spontaneous triceps hematoma and radial nerve impairment due to warfarin use

“…Symptoms and signs include pain in the distribution area of the involved nerve, sensory deficit and motor involvement. Although neuropathy after hematoma has been reported in the literature, reports of radial neuropathy are rare (1,4). Here, we aimed to discuss a patient with a hematoma in the triceps muscle after warfarin use and associated radial nerve impairment.…”